Oklahoma City Clinic, PC – Family Medicine Physician, NPI 1376585034
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Oklahoma City Clinic, PC
2005 Parkview Dr Ste 2
El Reno, OK 730362145
Phone: (405) 776-1465
Fax: (405) 280-5780
Type: Location
1636 Midtown Pl
Midwest City, OK 731306347
Phone: (405) 869-7700
Fax: (405) 869-7724
Type: Location
225 Lilac Dr Ste 200
Edmond, OK 730347287
Phone: (405) 330-7000
Fax: (405) 330-7075
Type: Location
817 S Elm Pl
Broken Arrow, OK 740125369
Phone: (918) 251-2273
Fax: (918) 258-6446
Type: Location
PO box, Russell Road, Paoli, Tredyffrin Township, Chester County, Pennsylvania, 19301, United States
SECTION 4142
SAN ANTONIO, TX 78265
Phone: (405) 280-5634
Fax: (405) 280-5661
Type: Mailing
1720, Northeast 23rd Street, Oklahoma City, Oklahoma County, Oklahoma, 73111, United States
OKLAHOMA CITY, OK 731113324
Phone: (405) 280-5550
Fax: (405) 280-5780
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2003-11-03
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20031103000235 | O | Clinic/Group Practice | OK | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 73036)
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